Provider Demographics
NPI:1720213119
Name:RUDIN, ROBYNNE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBYNNE
Middle Name:M
Last Name:RUDIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBYNNE
Other - Middle Name:RUDIN
Other - Last Name:PROSSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1601 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3213
Mailing Address - Country:US
Mailing Address - Phone:310-302-0030
Mailing Address - Fax:
Practice Address - Street 1:1601 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 290
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3213
Practice Address - Country:US
Practice Address - Phone:310-302-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15405103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist